Mya Nelson
Apples, bananas, granola bars, and 100% whole wheat bread; these were just a few of the healthy food items we promoted in corner stores in Baltimore, Maryland, as part of the B’more Healthy: Retail Rewards program (BHRR) – a Johns Hopkins Bloomberg 
School of Public Health intervention project led by Dr. Joel Gittelsohn aimed at improving access and consumption of healthy foods for African American adults living in low-income areas of Baltimore.
Today’s Cancer Research Update has a piece on Dr. Gittelsohn’s work.
Approximately 68% of adults in Baltimore are either overweight or obese, which is higher than the percentage of overweight and obese adults nationally. Being overweight or obese increases the risk of diet-related chronic diseases such as diabetes, heart disease and cancer. In Baltimore, these diseases disproportionately affect low-income African Americans who tend to have diets low in fruits and vegetables and high in energy-dense processed fast food and sugary beverages.
Corner stores are ubiquitous in Baltimore neighborhoods; these are places people go, oftentimes multiple times a day to buy soda or chips. By increasing access and promoting healthy foods in corner stores, we hoped to improve and change consumption patterns in these areas.
As the first part of the project, we interviewed approximately 360 members of the community to collect baseline data. We also collected information, using a method called pile sorting, to identify the healthy foods to promote in the program. The program was a multi-level program working with consumers (the study participants), storeowners (the corner storeowners), and wholesalers (where the storeowners purchases their products). It was broken down into three phases: (1) beverages such as diet sodas and water, (2) essentials such as canned tuna in water and 100% whole wheat bread , and (3) snacks such as fruits and baked chips.
We worked with 24 corner stores and the stores were broken up into 4 study groups:
- Control group [no changes]
- Pricing – these stores received a discount from the wholesaler on the promoted foods, with the hope that they would pass that discount down to the consumers.
- Communication – these stores received health communication materials to promote healthy foods such as posters, handouts, recipe cards and interactive sessions.
- Both pricing and communication.
We wanted to see whether the price of healthy foods or the communication aspect of promoting healthy foods would have a greater impact on healthy foods purchase at the corner stores.
As a student investigator on the project, my most memorable moments were the interactive sessions where we spent a few hours at the corner stores communicating with the consumers. We developed healthy recipes using the promoted foods and would provide food taste tests. We also created educational displays on the amount of fat in different kinds of milks, and educational displays on the amount of sugar in different sodas.
The best moments were when consumers would thank us and tell us that they learned from us something they didn’t know before. Or when they tried one of the healthy recipes, such as the tuna salad made with plain yogurt, and were astounded it tasted so good despite being made with yogurt and then, that they were going to go home and start making tuna with yogurt.
One moment I remember vividly was between a storeowner and a customer. A woman with two small twin boys came into the store and one boy reached for an orange that was in a box near the cash register. He looks at his mother and tells her he wants the orange. She grabs it from him and says: “no, that’s too expensive.” Instead, she opens the door to the ice cream freezer and pulls out a fruit popsicle and tells him to eat that. The kid shakes his head vehemently; he really didn’t want the popsicle. The storeowner sees this entire exchange and tells the mother that she can have the orange for free and the boy leaves with a smile on his face cupping the orange with his two little hands.
The price difference between the orange and the popsicle was probably around 25 cents so it was that moment that really showed to me how the price of food, even a 25 cent difference, could make or break a child receiving a piece of fruit. Interactions like those were important because it reminded me that the BHRR project was truly making a difference in the community.
Debra Liu, MSPH, is currently doing marketing and social media work at a NYC-based online food delivery and catering start-up called FoodtoEat. She is interested in food, health and nutrition and did her masters thesis work at Johns Hopkins School of Public Health.
